1. Field of the Invention
This invention relates to surgical devices and procedures and more specifically to an apparatus for suturing openings in a patient during endoscopic surgical procedures.
2. Description of Related Art
In endoscopic surgical procedures, all the techniques of dissection and suturing, including knot tying, must be performed with various elongated instruments that extend through trocars into a cavity of a patient. These instruments generally include needle holders, tissue graspers, introducers and related instruments for facilitating both extracorporeal and intracorporeal knot tying and suturing during endoscopic surgical procedures. During such endoscopic surgical procedures the needle holders and knot tying devices are generally among the final devices to inserted into and removed from the trocars to suture the patient's tissue.
The following United States Letters Patent disclose representative needle gripping and driving apparatus for use during endoscopic surgical procedures:
______________________________________ 3,878,848 (1975) Hiebert 5,015,250 (1991) Foster 5,300,082 (1994) Sharpe et al. 5,312,422 (1994) Trott 5,364,409 (1994) Kuwabara et al. 5,376,096 (1994) Foster ______________________________________
U.S. Pat. No. 3,878,848 to Hiebert discloses a needle capturing device. This device includes a handle member at one end and a tip in the form of a solid block which may be penetrated by a surgical needle so that manipulation of the handle member permits manipulation of the suture needle penetrating the block.
U.S. Pat. No. 5,015,250 to Foster discloses a needle driver for selectively grasping a suture needle. A cross-channel in an overlying sheath receives the suture needle. A distal end of a slidable inner rod supported within the sheath grips the needle by distally pushing it against a wall of the cross-channel. Proximal manipulation of a handle portion supported at a proximal end of the sheath and the inner rod enables retraction and extension of a distal end of a inner rod relative to the channel for selectively grasping and releasing the suture needle.
U.S. Pat. No. 5,300,082 to Sharpe et al. discloses a surgical instrument having a trigger handle for grasping a needle at a distal end of a tubular member. The distal end includes a cross-notch or channel for receiving the needle whereby an end of the inner tube clamps the needle against a distal end of the notch. The trigger handle includes a latching device that selectively locks the needle members in position when the needle is engaged.
U.S. Pat. No. 5,312,422 to Trott discloses a suturing needle apparatus that includes an elongated handle with a push block that connects with a slide actuated thumb switch. The push block also connects with an elongated needle assembly that extends distally from the handle. The distal end of the needle portion is selectably retractable relative to a distal end of an overlying sheath member to retain a suture in a slot of the needle. A finger switch overcomes a lock feature that inhibits unintended extension of the needle assembly.
U.S. Pat. No. 5,364,409 to Kuwabara et al. discloses a needle holder for gripping a needle within a body cavity. The disclosed device includes an elongated tubular member underlying a sheath. A fixed needle holding element and a movable holding element support at a distal end of the tubular member come together with the fixed element in a scissors-like fashion to grip a needle. An inner core extending from a biased scissors-like handle slides in the tubular member responsive to manipulation of the handle to actuate the movable holding element between the gripping and released positions. The outer surface of the tubular member also includes a suture hook or fixing element to assist in the formation of loops for tying the suture in an overhand knot.
U.S. Pat. No. 5,376,096 to Foster discloses a needle driver for selectively grasping a suture needle. A channel in a distal end of a slidable inner rod supported within an overlying sheath grips the needle in the channel against a distal end of an overlying sheath. Manipulation of a handle portion supported at a proximal end of the sheath and inner rod enables retraction and extension of the inner rod relative to the sheath for selectively grasping and releasing the suture needle.
The following United States Letters Patent disclose representative apparatus for intracorporeal knot tying in endoscopic surgical procedures:
______________________________________ 5,281,236 (1994) Bagnato et al. 5,336,230 (1994) Leichtling et al. 5,391,176 (1995) de la Torre et al. 5,447,512 (1995) Wilson et al. ______________________________________
U.S. Pat. No. 5,281,236 to Bagnato et al. discloses a method and device for intracorporeal knot tying. The device includes a proximal control apparatus, a distally extending, axially stiff sheath, and a distally extending tubular member formed of shaped memory material for carrying a suture thread through a through passage in the tubular member. The tubular member includes a bight formed of a shape memory material at its distal end that upon selective extension from the sheath forms a loop and upon retraction into the sheath returns to a linear extension. When the tubular member is extended from the sheath and a free end of the suture material extends through the tubular member is passed through the loop, retracting the tubular member forms an overhand knot: in the suture material. Subsequent tightening of the knot is performed by pulling the suture material proximally through the tubular member while grasping with a grasping device the free end of the suture material.
U.S. Pat. No. 5,336,230 to Leichtling et al. discloses an endoscopic suture tying apparatus that includes a proximal operating section with scissors-like members for external manipulation by a surgeon to control a distal section extending internally of a patient. The distal section comprises first and second hollow tube members having a bore therein and a push/pull rod slidably mounted in the bore of each of the tubular members. The scissors-like member secures to the proximal end of each of the tube members for selectively moving the push/pull rods. The ends of the tube are used to selectively loop suture material and pull the suture material through the loops to knot the suture material.
U.S. Pat. No. 5,391,176 to de la Torre et al. discloses a surgical instrument and method for tying knots in a length of suture material at a remote location. The device includes a hollow tube with suture threads wrapped in axially spaced loops proximate a distal end of the tube. A proximally extending slot at the distal end of the tube underlies the spaced loops. Passing a suture needle secured to the free end of the suture material into the distal end of the tube and out of the slot proximally of the distal most loop forms an overhand knot in the suture material.
U.S. Pat. No. 5,447,512 to Wilson et al. discloses an intracorporeal knot tying device with a proximal controller or handle and a distal portion substantially identical to the distal portion of the device disclosed by U.S. Pat. No. 5,281,236 to Bagnato et al., as described above. The controller includes a housing that supports a slide button for selectively extending and retracting the tubular member relative to the sheath. The slide button also enables the user to engage the suture material as the slide button retracts the tubular member so as to pull one side of an intercorporeal knot formed proximate a distal end of the tubular member.
The foregoing references disclose various apparatus for gripping and driving needles during intracorporeal knot tying. However, they fail to disclose a singular apparatus that enables grasping and driving a needle in order to suture a patient's tissue and that facilitates intracorporeal knot tying to secure the suture. The apparatus disclosed by these references also fail to provide an easily used control apparatus that holds needle grasping members in open and closed positions to positively grasp and release a suture needle when selectively moved to such positions. Further, the references fail to teach a device with a needle grasping apparatus at a distal end and a proximal operating apparatus that controls both the needle graspers and a second catheter extending distally in the device for providing alternative or additional therapeutic modalities of treatment.